Self-Service Tools

We value your participation with Highmark and the quality service you provide to our members. We have made significant investments in our self-service tools to reduce administrative burden, improve office workflows, and simplify complex transactions — allowing you and your staff to focus on delivering care to our members.  

As a result of this evolution, Highmark requires providers to utilize our enhanced self-service tools to obtain the fastest resolution to many common issues and tasks. This allows our Provider Service advocates to assist with more complex issues and your staff avoid unnecessary hold times on the telephone. 

  • Highmark’s Provider Resource Center (PRC): You are here! The PRC is the main hub for you and your staff to review important information and tools, such as EFT registration, policies, procedures, and the Provider Manual. 
  • Interactive Voice Response (IVR) System: The Provider Service Center offers options for you to access information, such as claim status or member benefits, without a live agent.  

Our wide range of self-service tools available 24/7. Use the below chart as a reference if you are unsure of where to start. Download here. 


Inquiry Examples

1st Level 2nd Level

Self Service 

(required for many transactions)

Provider or Clinical Service

Authorization Appeals / Grievances

•Confirm status of retrospective reviews and appeals

•Appeal sent but not received

•Disputing decision

Availity: Status check for Retrospective Reviews & Appeals

Peer-to-Peer: (866) 634-6468 to schedule

Contact Regional Provider Service: Contact Page

Authorization & Pharmacy

•Urgent or non-urgent prior authorization requests

•Post-acute discharge

•Check authorization status

Availity: Submit authorization, check status or make changes

Portal Submission Guides: Inpatient Authorization Submission (Both Urgent and Non-Urgent);

Outpatient Authorization Submission 

Contact Clinical Services or Pharmacy: Contact Page (If services are within 72 hours, Post-Acute or Pharmacy related)


•Claim didn’t process correctly or according to expectation

•Adjustment has not been completed timely

•Submitted adjustment bill and claim has been rejected as duplicate rather than adjustment

•Status of submitted claim

AvailityClaims inquiries/direct messaging (including follow-up to an initial inquiry) 

Interactive Voice Response: Can be used to check claims status (Contact Page)


•Contract payment was made incorrectly

Contact Regional Provider Service: Contact Page

Eligibility & Benefits 

•View member ID card

•Member cost share

•Deductible renewals

•New benefit year information

Availity: Benefits and eligibility check

Contact Regional Provider Service: Contact Page

Medical Policy

•Medical necessity and coverage guidelines

•Coding guidance

Provider Resource Center​: Commercial Medical Policy Search Tool
Delaware; New York; Pennsylvania, West Virginia

(Highmark adheres to the Centers for Medicare and Medicaid Services coverage determinations for Medicare Advantage membership.)

Contact Regional Provider Service: Contact Page


•Didn’t receive file for claims payment

•Don’t understand file

•Didn’t get payment file (EFT)


Highmark EDI​: (800) 992-0246​

Highmark EDI: Satisfaction Survey

Contact Regional Provider Service: Contact Page


ECHO Support: (800) 890-4124

ECHO: User guide

Last updated on 5/8/2024 11:17:08 AM


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